Validation of the VasCog-2-WSO VCID Criteria in a Dementia-Free and Stroke-Free Community Cohort: Cardiovascular Risk...

Vascular cognitive impairment and dementia (VCID), a major contributor of dementia, remains underrecognized, owing to the absence of universally accepted diagnostic criteria. The VasCog Society and WSO recently released updated criteria (VasCog-2-WSO); however, their applicability is unknown yet. We aimed to evaluate these criteria in a dementia-free and stroke-free community cohort and determine their associations with vascular burden and long-term mortality.

We conducted a community-based cohort study using data from the I-Lan Longitudinal Aging Study. Adults aged 50 years or older without prior stroke or dementia underwent standardized brain MRI and comprehensive neuropsychological assessment. VCID was classified according to the VasCog-2-WSO criteria using a neuroimaging-first approach. Participants were categorized as non-VCID, preclinical VCID (with or without objective cognitive impairment), or vascular mild cognitive impairment (vaMCI). Baseline 10-year Framingham cardiovascular disease risk was assessed. The primary outcome was all-cause mortality over a mean follow-up of 9.4 years, analyzed using multivariable Cox proportional hazards and Poisson regression models.

A total of 1,236 participants (62.7 ± 8.8 years; 52.9% female) were included. Neuroimaging evidence of cerebrovascular disease was present in 19.6% of participants; 19.2% met criteria for preclinical VCID and 0.4% for vaMCI. Compared with non-VCID participants, neuroimaging-positive groups had worse cognitive performance and higher 10-year cardiovascular risk. Mortality increased across the VCID spectrum (7.4 [95% CI 5.7-9.4], 24.9 [16.0-37.1], 27.4 [18.2-39.6], and 137.9 [37.6-353.2] per 1,000 person-years). In adjusted Cox models, preclinical VCID was associated with a 1.5-1.7-fold higher mortality risk, and vaMCI with a hazard ratio of 7.2 (95% CI 2.4-21.1), with a significant graded association across the spectrum (p for trend <0.001).

The VasCog-2-WSO criteria identify a spectrum of MRI-defined vascular cognitive vulnerability associated with increased cardiovascular risk and mortality, with excess mortality risk detectable at a neuroimaging-defined preclinical stage before overt cognitive impairment. These findings support their utility for early detection and risk stratification in community settings. A key limitation is the inability to assess mixed etiologies due to the absence of genetic data and Alzheimer disease biomarkers, which limits the ability to thoroughly evaluate the VasCog-2-WSO VCID diagnostic framework.